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Multimorbidity most significant risk factor for polypharmacy in older patients

Patients aged 75 to 85 years with more than eight diagnosed diseases or conditions were at the highest risk for polypharmacy, according to findings recently published in BMC Family Practice.

“In some cases, polypharmacy may be inevitable, however, in many patients it appears to be inappropriate,” Anja Rieckert, MSc, of the Institute of General Practice and Family Medicine at Witten Herdecke University in Germany, and colleagues wrote.

“To our knowledge no study so far has analyzed possible predictors for excessive polypharmacy in patients consuming multiple drugs. Given the increased risk of adverse health outcomes in older adults taking 10 or more medications it is important to investigate which factors contribute to excessive polypharmacy,” they added.

Researchers reviewed data from 3,904 participants from several primary care centers in the United Kingdom, Germany, Italy and Austria who were aged 75 years and older, taking at least eight medications regularly and part of a previous trial that also studied polypharmacy.

Rieckert and colleagues found that the most significant risk factor associated with excessive polypharmacy was eight or more diagnoses (OR = 2.64; 95% CI, 2.24-3.11), followed by a lower SF-12 physical health composite score (OR = 1.47; 95% CI, 1.26-1.72), frailty (OR = 1.45; 95% CI, 1.22-1.71), a lower SF-12 mental health composite score (OR = 1.33; 95% CI, 1.17-1.59) and a BMI of 30 kg/m² or higher (OR = 1.18; 95% CI, 1.02-1.38).

Conversely, no link could be found between smoking, low educational level and being female and excessive polypharmacy, while patients aged 85 years and older were at significantly lower risk for polypharmacy (OR = 0.83; 95% CI, 0.7-0.99).

“Understanding the health characteristics of an aged population taking several drugs, and investigating factors influencing excessive polypharmacy is highly relevant in times when the geriatric population is growing. This study helps to develop targeted strategies to reduce polypharmacy by identifying factors contributing to excessive polypharmacy,” Reichert and colleagues wrote.

“Physicians should especially pay attention to their frail, obese patients that have eight or more diagnoses, check whether all medications are necessary, evidence-based and appropriate, and whether there are relevant interactions. To do so, [general practitioners] should perform medication reviews for their patients with excessive polypharmacy on a regular basis to optimize these patients’ medication. They should allocate extra time to care for these complex patients,” they added. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.